Ovarian Cancer
The ovaries are two white sacs of eggs located in the pelvis and from which eggs or follicles ripen and ovulate off each month.
The menopause occurs at about 50 years because the supply of eggs comes to an end. The hormone oestrogen made in the ovary falls in the blood and menopausal symptoms such as hot flushes, sweats, tiredness and insomnia may be experienced.
The ovaries remain small and shrivelled for the rest of the woman’s life.
Cancer in the ovaries can start quietly usually in older women over 60 years. It is often diagnosed late because the ovaries do not respond to cancer with pain or bleeding to alert the woman.
Small white growths that look like bubbles and lumps develop and pieces break off and travel to other organs in the abdomen.
Fluid is produced and the abdomen swells. Slowly pressure builds up and this causes abdominal bloating and discomfort especially after eating. Sometimes a lump can be felt in the abdomen.
Because the symptoms are diverse patients are often not diagnosed until late in the disease.
The symptoms of ovarian cancer can mimic an urinary infection, irritable bowel and weight gain of the middle years. Pain is not usually a major symptom.
The cause of ovarian cancer is not known, but in some families it has been linked to a gene that is also implicated in breast cancer so a family history of ovarian cancer requires extra surveillance to be instituted.
The oral contraceptive pill is a protection against ovarian cancer and prescribed for women at risk as it reduces the activity of the ovaries.
Fertility stimulating drugs, such as clomiphene, have been highlighted as a possible cause, but this has not been borne out in research studies.
Hormone replacement therapy. HRT has not been implicated in ovarian cancer.
What are the symptoms of ovarian cancer
These are vague and non specific, but include:
- Increasing abdominal girth - tight waistbands - bloating.
- Abdominal discomfort.
- Frequency of micturition.
- Loss of appetite.
- Dyspepsia or discomfort after eating.
- Tiredness and lassitude.
- The GP may find a lump in the abdomen.
Problems with diagnosis
Ovarian cancer tends to be diagnosed late because symptoms only develop when the tumour or growth has spread around the tummy cavity. This is why it is called ‘the silent killer’.
The cancer tissue produces a special tumour marker called Ca125 which enters the bloodstream and can be detected in a blood sample.
Very large studies have now taken place on the value of a blood Ca125 to detect early cancer in women who wish to be screened. The early promise of a good and reliable screening test has not been fulfilled and some women with advanced ovarian cancer can have normal levels of Ca125 in their blood.
Ultrasound of the ovaries is the mainstay diagnostic tool. This is a transvaginal scan (probe passed into the vagina) that shows up the size and shape of the ovaries. If they are small and normal this is reassuring. If they are enlarged or have a cyst present then further investigation is indicated.
There is no test that is specific and 100% reliable for the detection of ovarian cancer. We do recommend an examination, a scan and a blood test every 3 years after the age of 58 and at 40 years for women with a history of ovarian cancer in the family.
We have also seen sporadic cases of ovarian cancer in women in their 30’s and 40’s, but they represent unusual cases and routine screening in this age group is not justifiable.
Ovarian cancer diagnosed early has a good outcome, but sadly most cases are diagnosed late in the disease. When the diagnosis is made when the cancer is still confined to the ovary the 5 year survival rate is 70%. When the cancer is diagnosed after it has spread around the abdomen the 5 year survival rate is 15%.
This is why it is important to diagnose ovarian cancer early. Is this possible? Well we have to start somewhere. Any woman with the following symptoms over 50 years of age should be investigated with a pelvic scan:
- Bloating.
- Increasing abdominal girth.
- Tiredness.
- Weight loss.
- Not eating well.
- A lump felt in the lower abdomen.
Tests performed
- A physical examination.
- Blood tests.
- Ultrasound pelvic scan
If an abnormality is found on the ovary further tests, such as:
A laparoscopy – looking inside the abdomen under an anaesthetic to check the organs and take a biopsy.
An MRI – Scan to detect the extent of the disease.
We offer these preliminary tests to check and make the diagnosis and if ovarian cancer is detected referral on to a specialist oncology service is made.
If you would like to undergo the screen please phone us on 020 7722 8328 for an appointment.